A preschool-aged child who is experiencing respiratory distress is brought to the emergency department by the parents. The child is anxious, has a temperature of 102.8° F (39.3° C), and is drooling from the mouth while leaning forward when sitting. Which action should the nurse prepare the child for next?

Choice A reason: Assessing for presence of a supernumerary breast nipple is not a relevant technique to determine if the client has reached the age of menarche. A supernumerary breast nipple is an extra nipple that develops along the embryonic milk line, usually in the chest or abdomen. It is a congenital anomaly that affects about 1% to 5% of the population, and it has no relation to the onset of menstruation.

Choice B reason: Using the Tanner staging to determine sexual maturity is a valid technique to determine if the client has reached the age of menarche. The Tanner staging is a scale that assesses the development of secondary sexual characteristics, such as breast growth, pubic hair growth, and genital development, in relation to the chronological age of the child. The Tanner staging can help estimate the stage of puberty and the likelihood of menarche, which usually occurs around Tanner stage 3 or 4 in girls.

Choice C reason: Palpating for evidence of temporary gynecomastia is not an appropriate technique to determine if the client has reached the age of menarche. Gynecomastia is the enlargement of breast tissue in males, due to hormonal imbalance, medication side effects, or other causes. It is a common condition that affects up to 70% of adolescent boys, and it usually resolves spontaneously within a few months or years. Gynecomastia has no relevance to the onset of menstruation in girls.

Choice D reason: Calculating approximate age menstruation should occur is not a reliable technique to determine if the client has reached the age of menarche. The age of menarche varies widely among individuals, depending on genetic, environmental, nutritional, and psychosocial factors. The average age of menarche in the United States is about 12.5 years, but it can range from 8 to 16 years. Therefore, calculating the approximate age of menarche based on averages or norms may not reflect the actual situation of the client.

Choice A reason: Chest pain is a sign of acute chest syndrome, which is a life-threatening complication of sickle cell crisis. It occurs when the sickle-shaped red blood cells block the blood vessels in the lungs, causing inflammation, infection, and low oxygen levels. Chest pain may be accompanied by fever, cough, shortness of breath, and wheezes. The nurse should report chest pain to the health care provider immediately and monitor the child's vital signs, oxygen saturation, and respiratory status.

Choice B reason: Jaundice is a common finding in children with sickle cell disease, but it is not an urgent sign of sickle cell crisis. Jaundice occurs when the red blood cells break down faster than the liver can process them, resulting in a buildup of bilirubin in the blood and skin. Jaundice may cause yellowing of the skin, eyes, and mucous membranes, as well as itching and dark urine. The nurse should assess the child's liver function and hydration status, but jaundice does not require immediate intervention.

Choice C reason: Ulcers on the legs are a chronic complication of sickle cell disease, but they are not an acute sign of sickle cell crisis. Ulcers on the legs occur when the blood flow to the skin is impaired by the sickle-shaped red blood cells, causing tissue damage and infection. Ulcers on the legs may cause pain, swelling, and drainage, and they may take a long time to heal. The nurse should clean and dress the ulcers, apply topical antibiotics, and elevate the legs, but ulcers do not require immediate intervention.

Choice D reason: Swelling in the hands or feet is a common finding in children with sickle cell disease, especially in infants and toddlers, but it is not a critical sign of sickle cell crisis. Swelling in the hands or feet occurs when the sickle-shaped red blood cells block the blood vessels in the extremities, causing inflammation and fluid retention. Swelling in the hands or feet may cause pain, stiffness, and difficulty moving the joints. The nurse should apply warm compresses, massage the affected areas, and encourage the child to exercise the joints, but swelling does not require immediate intervention.